Beyond Tired

If you find yourself dozing at your desk now and then, don’t be embarrassed. You aren’t alone. In a 2008 poll conducted by the National Sleep Foundation, nearly one-third of American adults who worked at least 30 hours a week said they have fallen asleep or become extremely drowsy on the job. The culprit is usually too much work and too little sleep. Sometimes, though, it’s more than mere sleepiness — it’s fatigue.

Fatigue is a feeling of weariness and lack of energy that persists despite how much sleep you get — and this persistence is the key difference between just feeling tired and something more serious. Why do some people suffer from fatigue? There are many potential causes.

Work. The average American now works about 170 hours more each year than he or she did in the 1960s, according to an analysis of government survey data by Harvard-based economist Juliet Schor. If you count work at home as well as work in the workplace, the work week has been growing even longer — particularly for women. Equally important is the other side of the coin: we have lots less free time for play, relationships, and hobbies. Too much work and no play can make Jack and Jill dull and fatigued.

Stress. The constant drip-drip-drip of little threats to safety, security, and peace of mind — the traffic jam, the unreasonable boss, the surly teenager, the frail parent — keeps the body’s stress response constantly on. That can alter brain chemistry and generate fatigue.

Depression. Unrecognized and untreated depression is one of the most common causes of persistent fatigue.

Medical conditions. Fatigue can be a sign of anemia, an underactive thyroid gland, sleep apnea, inflammation of the heart’s valves (endocarditis), heart failure, multiple sclerosis, chronic fatigue syndrome, cancer, and a host of other conditions.

Drug side effects. Some otherwise valuable drugs, including some antihistamines, blood pressure pills, and psychiatric medications, can cause fatigue.

There are several strategies that I recommend to my patients with fatigue. Regular exercise tops the list. It improves energy and generally helps produce a deeper, more restorative sleep. Just beware of exercising too late in the evening, which might make you wired just as you’re trying to go to bed.

Getting a better night’s sleep comes next. Avoid caffeinated beverages after noon and nicotine all the time, since they act as stimulants, disrupting sleep in many people. An alcoholic nightcap may help you fall asleep, but it interrupts deep sleep several hours later.

Frequent, small meals can sometimes help. Large meals cause a surge in blood sugar, which prompts the release of large amounts of insulin. All that insulin causes blood sugar to drop precipitously, which can cause fatigue.

Stress-busting relaxation therapies also work for many people with fatigue. Believe it or not, so does taking 20 minutes a day to write about your stressful experiences. Finally, getting outdoors is another potential solution. Harvard biologist Edward O. Wilson calls it “biophilia” — the restorative connection we feel to the natural world.

Anthony L. Komaroff, M.D., is a professor of medicine at Harvard Medical School and the editor in chief of Harvard Health Publications.

Anthony L. Komaroff, MD is a professor of medicine at Harvard Medical School and the editor in chief of Harvard Health Publications.

Partner Center

The email and password entered aren’t matching to our records. Please try again, or reset your password. If you have a username from our previous site, start by using that. Please See our FAQ for more.

If you are signing in for the first time on the new HBR.org but have an existing account, please enter your existing user name and password to migrate your account.Please see Frequently Asked Questions for more information.